What does the densitometry result mean?
Bone density is assessed using dual-energy X-ray absorptiometry and expressed as a T-score - how much the result differs from the bone density of a healthy young adult. The norm corresponds to a value above minus 1.0. The range from minus 1.0 to minus 2.5 is considered osteopenia, below minus 2.5 is osteoporosis. In people under 50 years of age and in children, a different indicator, the Z-score, is used. It is important to understand that the number is not a death sentence: the doctor evaluates it along with age, previous fractures and other risk factors.
- T-score above −1.0 is normal
- From −1.0 to −2.5 - osteopenia
- Below −2.5 – osteoporosis
- Measure the lumbar vertebrae and femoral neck
- A follow-up study is usually prescribed no more often than after 1–2 years.
Why does bone lose density?
Bone tissue is constantly renewed: some cells destroy old bone, others build new one. Until about 25–30 years of age, accumulation predominates, then the balance gradually shifts towards loss. In women, the process accelerates in the first years after menopause due to a decrease in estrogen. Additionally, the bone suffers from a lack of vitamin D and calcium, inactivity, smoking, excess alcohol, as well as from a number of diseases and medications. A separate and common cause in our latitudes is vitamin D deficiency in people who spend little time in the sun.
- Age-related decline and menopause
- Vitamin D deficiency and low calcium intake
- Sedentary lifestyle, prolonged bed rest
- Smoking and alcohol abuse
- Glucocorticoids, anticonvulsants, some oncology regimens
- Thyrotoxicosis, hyperparathyroidism, celiac disease, rheumatoid arthritis
Are there any symptoms?
Osteopenia itself does not hurt. The widespread belief that aches in bones and joints indicates a lack of calcium is erroneous - these complaints are more often associated with arthrosis, muscle strain or vitamin D deficiency. The first manifestation of bone loss is often a fracture due to a minor injury: the wrist when falling on the hand, a vertebra when sharply tilted, or the femoral neck in an elderly person. Therefore, it makes sense to measure bone density before the onset of complaints, focusing on risk factors.
- Usually no complaints
- Possible fractures due to minor trauma
- Gradual decline in growth
- Strengthening the thoracic curve of the spine
- Chronic back pain after a compression fracture
What examinations are needed
The main method is densitometry of the lumbar spine and femoral neck. An X-ray does not evaluate normal bone density, but it helps to see compression fractures of the vertebrae that have already occurred, which a person may not be aware of. The laboratory part is needed to find a removable cause: they check vitamin D, calcium and phosphorus, parathyroid hormone, alkaline phosphatase, thyroid function, and in men, testosterone. If malabsorption is suspected, the intestines are additionally examined.
- Densitometry (DXA) of the spine and hip
- Vitamin D (25-OH)
- Total calcium and blood phosphorus
- Parathyroid hormone and alkaline phosphatase
- TSH, if indicated - sex hormones
- X-ray of the spine to detect compression fractures
What to do: nutrition, exercise, treatment
At the stage of osteopenia, the main work falls on lifestyle. Body weight and resistance activities strengthen your bones: brisk walking, climbing stairs, weight-bearing exercises, and balance training, which reduces the risk of falls. The diet should cover the need for calcium - these are dairy products, katyk, cottage cheese, cheese, sesame seeds, greens, fish with small bones. Vitamin D is replenished according to the results of the analysis under the supervision of a doctor. Medicines that reduce bone destruction are not prescribed to everyone for osteopenia, but only to those with a high calculated risk of fracture or a fracture that has already occurred. The doctor makes the decision; taking high doses of calcium and vitamin D on your own is unsafe.
- Regular weight-bearing exercise, at least 30 minutes most days
- Strength and balance exercises
- Adequate calcium intake from food
- Correction of vitamin D deficiency by analysis
- Stop smoking, limit alcohol and excess caffeine
- Preventing falls at home: lighting, rugs, handrails
- Review medications that worsen bone health with your doctor